Medical Director for Health Plan

About the Role

Evry Health is hiring a tech-savvy Medical Director to lead medical policy and utilization management for a growing, technology-enabled health plan. In this role, you will work closely with teams across actuarial, technology, care coordination, and medical quality management to shape how care is delivered and improved for members.

• Lead utilization management strategy, including medical necessity determinations and review processes.
• Own medical policy development, incorporating regulatory updates and care guideline changes.
• Lead and Partner with the Utilization Management Review Committee.
• Provide medical oversight and leadership to ensure the delivery of cost-effective, quality healthcare services.
• Promote positive relations with the local medical community, including consultation with providers and facilities.
• Review case management data to identify trends, gaps in care, and recommend corrective actions.
• Integrate clinical quality and best practices into medical management program development.

• Active, unrestricted Texas (TX) medical license.
• Doctor of Medicine (MD) with 8+ years of clinical experience; management experience preferred.
• Board certification in a specialty recognized by the American Board of Medical Specialties.
• Experience working within a health insurance plan with an emphasis on population health.
• Experience in managed care and utilization management, including performing utilization reviews.
• Knowledge of MCG or other clinical guidelines.

This is a remote position. Candidates must reside in the United States in the Eastern or Central time zones and work during business hours (9-5 CST).

Required Skills